Uso da broncoscopia virtual em pacientes pediátricos com suspeita de aspiração de corpo estranho
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Abstract:
A aspiração de corpo estranho (ACE) para o trato respiratório é um problema comum em pacientes pediátricos, em especial abaixo dos três anos de idade. Na avaliação radiológica inicial, cerca de 30% dos pacientes apresentam radiograma de tórax normal. A tomografia com broncoscopia virtual (BV) pode auxiliar no diagnóstico precoce desse quadro e seu pronto manejo. O tratamento definitivo se dá com a retirada do corpo estranho através de broncoscopia rígida e mediante anestesia geral. O objetivo deste trabalho foi descrever o uso da BV na abordagem de dois pacientes com suspeita de ACE e realizar uma revisão da literatura sobre este tópico. Os dois pacientes tiveram início súbito de sintomas respiratórios e relato de tosse ou engasgo com alimentos antecedendo o quadro. Os pacientes foram submetidos à BV, e foi detectada a presença de corpo estranho endobrônquico em ambos os casos, com remoção posterior por broncoscopia rígida convencional em um caso. A BV é um método não-invasivo recente e com potencial para detectar a presença de corpo estranho na via respiratória em crianças. Em casos selecionados, BV pode auxiliar na localização correta do corpo estranho e até mesmo evitar o procedimento de broncoscopia rígida na ausência de corpo estranho.Keywords:
Choking
Foreign body aspiration
Rigid bronchoscopy
Flexible bronchoscopy
Foreign Body Removal
Flexible bronchoscopy is the most commonly used tool for the diagnosis of foreign body aspiration (FBA) and the preferred instrument for foreign body removal in adults. In children, the most common procedure performed for removal of foreign bodies is rigid bronchoscopy with or without the use of adjuvant flexible bronchoscopy. This chapter reviews the role of flexible bronchoscopy in foreign body removal in both the adult and pediatric populations. The management of foreign body removal is addressed by exploring three different therapeutic approaches: postural drainage, rigid bronchoscopy, and flexible bronchoscopy. The chapter discusses a case study of a previously healthy 34-year-old male found to have an incidental finding of a radiopaque foreign body on the chest radiograph. The foreign body removal procedure was performed in a fully equipped bronchoscopy suite under moderate sedation with intravenous midazolam and morphine.
Rigid bronchoscopy
Flexible bronchoscopy
Foreign body aspiration
Foreign Body Removal
Midazolam
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Foreign body aspiration is a worldwide health problem and often associated with life threatening complications. A high index of suspicion and careful history taking are important as symptoms can be non-specific and easily overlooked. There are no specific tests for diagnosis although chest imaging can be useful. Flexible bronchoscopy is often needed for diagnosis and treatment; however, rigid bronchoscopy may be necessary in certain situations. We report the case of young woman who accidentally aspirated an unusual sharp foreign body, requiring both flexible bronchoscopy and gastroscopy for ultimate removal. Key words: Bronchoscopy,foreign body aspiration,hijab pins
Foreign body aspiration
Flexible bronchoscopy
Rigid bronchoscopy
Foreign Body Removal
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A systematic review of using flexible bronchoscopy to remove foreign bodies from paediatric patients
Our aim was to summarise the evidence about flexible bronchoscopy for paediatric airway foreign body aspiration cases.We searched the PubMed database from 1 January 2001 to 9 October 2021 for peer-review papers published in English on the use, and success rates, of flexible bronchoscopy as the first-line treatment for foreign body aspiration cases. This process identified 243 potential papers.We studied 23 papers comprising 2588 cases of foreign body aspiration and flexible bronchoscopy successfully removed the foreign bodies in 87.1% of cases. Complication rates were low in the 983 patients studied in 18 papers. The foreign bodies were organic materials in 78.3% of 1371 patients and mainly lodged in the right bronchial tree in 50.5% of 1402 patients. General anaesthesia was used before flexible bronchoscopy in 14/23 studies and laryngeal mask airways were mostly used in 10/23 studies to secure the airway during the procedure. Ancillary equipment was used to assist the foreign body removal in 57.3% of 1808 cases and these were usually baskets.Flexible bronchoscopy was a feasible and safe therapeutic procedure for selected foreign body aspiration cases. Future studies need to focus on comparing the clinical outcomes of flexible and rigid bronchoscopies.
Foreign body aspiration
Flexible bronchoscopy
Foreign Body Removal
Rigid bronchoscopy
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Foreign body aspiration
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This chapter contains sections titled: Introduction Risk factors Clinical presentation Types of foreign body Radiologic evaluation Complications of foreign body aspiration Therapeutic approach to the patient with foreign body aspiration Removing an airway foreign body with a flexible bronchoscope References
Foreign body aspiration
Flexible bronchoscopy
Foreign Body Removal
Presentation (obstetrics)
Rigid bronchoscopy
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Foreign body aspiration (FBA) is more common in children than adults with about 80% occurring in children aged less than 15 years. FBA in adults is often overlooked as a potential cause of airway obstruction especially if there is no asphyxiation. We present a case of a 45-year-old male with alcohol abuse who presented with post-obstructive pneumonia secondary to aspiration of tooth of unknown duration. The tooth was removed via flexible bronchoscopy (FBr) and we will discuss the use of FBr for foreign body (FB) removal, which FB can be easily removed by FBr, and the different techniques and devices used for FB removal via FBr.
Foreign body aspiration
Foreign Body Removal
Flexible bronchoscopy
Airway obstruction
Aspiration Pneumonia
Rigid bronchoscopy
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Aspiration of foreign body, a clinical problem seen more commonly in the pediatric age group, is infrequently seen in the adult population. Although rigid bronchoscopy has been the mainstay of treatment, recently, easier manipulation, greater range of visulization, flexibility, topical anesthesia has made flexible bronchoscopy of choice for dealing with aspirated foreign body in adult. Operation increase morbidity and mortality, delay foreigh body removal. A 41-year old male was admitted to this hospital due to aspiration of pushpin. He showed high opaque density protruding in the orifice of right lower lobar bronchus. We report a case of foreign body removal by flexible bronchoscopy with brief review of the literature.
Flexible bronchoscopy
Foreign body aspiration
Foreign Body Removal
Rigid bronchoscopy
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Background. Most of foreign body aspiration cases are found in children under the age of fifteen. Pediatric patients often presents with non-food foreign body aspiration, such as toys. The most common clinical manifestation are history of choking following foreign object insertion into the mouth (85%), paroxysmal cough (59%), wheezing (57%) and airway obstruction (5%).
Case presentation. Main principle of airway foreign body extraction is to do it immediately in the most optimal condition with slightest possible trauma. Rigid bronchoscopy is a suitable choice for tracheal foreign body extraction. We reported a case of seven years old male with tracheal foreign body presented with history of whistle ingestion five hours prior to admission. This patient was discharged from hospital after third days of rigid bronchoscopy procedure.
Conclusion. History of foreign body aspiration in children should be suspected as a tracheobronchial foreign body. Rigid bronchoscopy is preferred to extract foreign bodies present in the trachea. The prognosis for tracheobronchial foreign body aspiration is good if the foreign body is treated early and without complications.
Choking
Foreign body aspiration
Rigid bronchoscopy
Foreign Body Ingestion
Airway obstruction
Foreign Body Removal
Presentation (obstetrics)
Flexible bronchoscopy
Right Main Bronchus
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Foreign body aspiration
Flexible bronchoscopy
Rigid bronchoscopy
Foreign Body Removal
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Purpose of review Anesthesia for foreign body removal in children can be quite challenging. Even though rigid bronchoscopy is considered the gold standard for foreign body removal, there is increasing evidence for successful foreign body removal using flexible bronchoscopy. This review discusses the recent implications for flexible bronchoscopy for the purpose of foreign body removal and will compare these findings to rigid bronchoscopy. Recent findings During the last few years, several observational studies on foreign body removal by flexible bronchoscopy have been published, with promising results. Summary Flexible bronchoscopy is a feasible and safe method for removing aspirated foreign bodies in children. In order to improve patient safety during the procedure, it is necessary for a pediatric anesthetist and a pediatric pulmonologist to work closely together. The anesthetist can take care of the administration of the anesthetic and maintenance of the vital functions, and the pulmonologist can carry out a safe and fast bronchoscopy. In the case of foreign body removal by flexible bronchoscopy, the anesthesiological procedure of choice should be general anesthesia with controlled ventilation via a laryngeal mask.
Pulmonologists
Foreign body aspiration
Foreign Body Removal
Flexible bronchoscopy
Rigid bronchoscopy
Gold standard (test)
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